Project Goal: This research will test methods of generating estimates of the prevalence of elder mistreatment (EM) in LTC settings (nursing homes & residential care facilities) housing over two million frail older persons, many of whom have cognitive impairment. Study results will have important implications concerning the feasibility of conducting a national study of physical and psychological abuse in residential LTC settings, as part of a broader national prevalence study. Specific Aims: The research team will pursue four aims: 1) Develop appropriate operational definitions of EM. Definitions of EM vary across relevant federal and state laws, interpretations by relevant agencies, mandated reporters, and victims. Developing appropriate definitions will involve discussions with other researchers; reviews of relevant literature, laws and regulations; discussions with those who routinely interview frail elders about abuse (APS); and testing definitions in focus groups and individual interviews with LTC residents and staff. 2) Test the utility of various methods for estimating prevalence. To achieve this goal, alternative methods for estimating the prevalence of EM will be tested, including interviews with cognitively intact residents about their experience and their observation of other residents and interviews with direct care staff about their knowledge of EM. Both anonymous response and randomized response techniques will be used to interview staff to determine which strategy produces the most comprehensive reports of abuse. This approach will allow the research team to determine which strategies best report on the experience of all residents. A major concern throughout this effort will be how best to obtain valid information about EM among those with significant cognitive impairment. 3) Identify potential resident, facility, and staff risk factors for abuse. This information, derived from multivariate models, will enhance understanding of the dynamics of EM and provide important information concerning possible sampling strategies for a national study. 4) Identify obstacles, recommend strategies, and assess the feasibility of conducting a national prevalence study of elder abuse in LTC facilities. Evaluating results for the other study aims and results developed by other research groups will allow the research team to address this final aim. Relevance to NIA Mission & Public Health. Available evidence suggests that EM is both serious and widespread. Thus, the study of elder mistreatment is relevant to at least two Healthy People 2010 objectives: #1-Access to Quality Health Services- Long-term Care...and #15-Injury and Violence Prevention. It is also clearly central to the mission of NIA -- "to improve the health and well-being of older Americans." [unreadable] The study to develop valid ways of measuring the nature and frequency of elder abuse in nursing homes and residential care facilities is a crucial step to detecting, understanding the causes, and preventing elder abuse. Thus, the study addresses the CDC's Healthy People 2010 goals of assuring "Access to Quality Health Services--Long-term Care" and of "Injury and Violence Prevention." [unreadable] [unreadable] [unreadable]